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Case Reports
. 2002;29(4):308-13.

Can stent-angioplasty be a valid alternative to surgery when revascularization is indicated for anomalous origination of a coronary artery from the opposite sinus?

Ramesh Hariharan  1 , Richard D Kacere, Paolo Angelini
Affiliations
Case Reports

Can stent-angioplasty be a valid alternative to surgery when revascularization is indicated for anomalous origination of a coronary artery from the opposite sinus?

Ramesh Hariharan et al. Tex Heart Inst J. 2002.

Abstract

When intervention is indicated for anomalous origination of a coronary artery from the opposite sinus, stent-angioplasty may seem more attractive than coronary artery bypass grafting. However, in the case of anomalous origination of a coronary artery from the opposite sinus, the anatomy is quite different from that encountered in atherosclerotic disease, and stent-angioplasty would involve unusual challenges, both in technique and prognostic outcomes. We illustrate these points by presenting the 2 first cases in which intervention was indicated because of severe symptoms. We conclude from this preliminary study that coronary artery bypass grafting should still be considered the preferred (although unproven) method of revascularization in patients who have symptomatic anomalous origination of a coronary artery from the opposite sinus. Until adequate data have been gathered to evaluate the late results of stent-angioplasty in these patients (in comparison with the results of surgical and medical treatment), the procedure should be performed only in selected patients, enrolled in prospective, controlled studies.

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Figures

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Fig. 1 Patient 1. A) Intravascular ultrasonographic (IVUS) image of the ectopic right coronary artery (RCA), at a segment just distal to the intramural segment. B) IVUS image of the intramural segment during maximal narrowing (end-systole). C) Ectopic RCA ostium, as revealed by IVUS. D) IVUS image of the stented intramural RCA. E) Angiographic appearance of the RCA in the left anterior oblique projection. No stenosis is recognizable in this projection. F) Angiographic appearance of the RCA in the cranial, right anterior oblique projection. A significant proximal stenosis is clearly visible.
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Fig. 2 Patient 2. Intravascular ultrasonographic (IVUS) images: A) Image obtained within the aortic root, illustrating the tangential, intramural course of the proximal right coronary artery (arrows). B) Intramural segment of the right coronary artery (RCA) during systole. C) Same segment as in B, during late diastole (maximal lumen). D) Intramural RCA after stent implantation.
See this image and copyright information in PMC

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